Step 5: Is the patient at risk of ADRs or suffers actual ADRs?

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Process

Identify patient safety risks by checking for

  • Drug-disease interactions
  • Drug-drug interactions (see ADR table)
  • Robustness of monitoring mechanisms for high-risk drugs
  • Drug-drug and drug-disease interactions
  • Risk of accidental overdosing (see Yellow Card Scheme)

 Identify adverse drug effects by checking for

  • Specific symptoms/laboratory markers (e.g. hypokalaemia)
  • Cumulative adverse drug effects (see ADR table)
  • Drugs that may be used to treat ADRs caused by other drugs

(Sick Day Rules Guidance can be used to help patients know what do  with their medicines if they fall ill)

Description
  • The presence of ADRs can sometimes be identified from laboratory data (e.g. hypokalaemia from diuretic use)
  • The patient may report such symptoms (including drug-drug and drug-disease interactions, but also the patient’s ability to self-medicate)
  • Ask the patient specific questions (e.g. about the presence of anticholinergic symptoms, dizziness or drowsiness). If patient is experiencing ADRs, use Yellow Card Reporting.
Drug Info
Drugs poorly tolerated in frail adults

See Gold National Framework on frailty

High-risk clinical scenarios

See ADR table

See “Sick day rules” cards

  • Metformin + dehydration
  • ACEI/ARBs + dehydration
  • Diuretics + dehydration
  • NSAIDs + dehydration
  • NSAIDs + ACEI/ARB + diuretic
  • NSAIDs + CKD
  • NSAIDs + age >75 (without PPI)
  • NSAIDs + history of peptic ulcer
  • NSAIDs + antithrombotic
  • NSAIDs + CHF
  • Glitazone + CHF
  • TCA + CHF
  • Warfarin + macrolide/quinolone
  • ≥2 anticholinergics (see Anticholinergics)